Provider Demographics
NPI:1417374141
Name:GUNTER PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:GUNTER PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-788-1925
Mailing Address - Street 1:3205 WELLINGTON WALK SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5452
Mailing Address - Country:US
Mailing Address - Phone:404-788-1925
Mailing Address - Fax:
Practice Address - Street 1:3205 WELLINGTON WALK SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5452
Practice Address - Country:US
Practice Address - Phone:404-788-1925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003145103TC0700X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty